Best Practice Guidance
Human Interaction with Technology in Dementia

Guidance

Applications that should be incorporated into EPR systems used in nursing homes providing care for people with dementia include a spell-check, a copy and paste function and a keyword search function. Log-in processes should be rapid and secure.

Explanation and Examples

The presence of a spell-check has been described as saving time on proofreading, as well as increasing legibility and comprehension of documentation. This allows for more time to be spent with residents with dementia in direct care, and for correct care to be provided. A copy and paste function also saves time by allowing staff to easily transfer information across sections of the EPR where information is often required to be replicated. A keyword function allows staff to enter a keyword and jump to the relevant section in a resident’s notes, allowing for more efficient retrieval of information, important in situations when a resident is unable to recall personal information. Rapid log-in processes should reduce barriers to using the EPR, as slow log-in processes have been found to prevent staff from accessing information about residents before delivering care, and have meant staff have been forced to pass on information about residents verbally instead of entering it into the EPR. This may mean important information regarding any sudden changes in an individual’s condition might be missed.

Guidance

When evaluating adherence of people with dementia to a computer-based cognitive rehabilitation program, sociodemographic, cognitive, and psychological factors should be taken into account.

Explanation and example

When we consider evaluating the adherence of people with dementia to a computer-based program for cognitive rehabilitation, it is important to consider sociodemographic (age, sex, educational level), cognitive (memory, attention, executive function) and psychological factors (level of motivation, expectations, previous computer use).

For this purpose, a periodic evaluation will help to evaluate these factors and their relation to the amount and the time that a person spends in using a computer program for cognitive rehabilitation. In this way, significant modifications could be made to the program, so that the program meets the needs of people with dementia.

Guidance

Issues such as access to the EPR system, appropriate training and system development and support should all be considered by nursing homes before and during the implementation of EPR systems.

Explanation and Examples

Access or non-access to various parts of the EPR system should be discussed and put in place. For instance, management should consider whether auxiliary staff should be allowed to access medical information, such as dementia diagnosis, and whether this would consequently entail training in the field of dementia. Appropriate training in the EPR system according to individual staff needs is also required, as some staff may be more experienced in the use of technology than others. Training ‘on the job’ was found to be preferred by many over classroom-based teaching. Finally, software developers should consider working alongside nursing homes during the design of EPR systems in order to ensure software is appropriate for their needs. Developers should continue to be involved in improving the EPR following implementation, as part of an iterative cycle.

Guidance

Researchers and technology developers should be aware of the mutual influence care recipients and caregivers have on each other, and the importance of maintaining and improving caregiving relationships. Therefore they should adopt a dyadic approach to the development, implementation and evaluation of technology-driven interventions by involving both members of the dyad.

Explanation and examples

A mixed-methods feasibility study investigated the impact of a tablet-based activation system on nine community-dwelling caregiving dyads living with dementia, their motivations to use social technology together, and facilitating and impeding factors in the independent use of social technology at home. In light of the SARS-CoV-2 pandemic, it was clear that the extent to which the caregiving dyads were influenced by the extreme social isolation depended on how socially active they were before the pandemic, and their familiarity with social technology. The dyads’ motivations for welcoming technology in their social interactions ranged from trying something new together, keeping up with society to communication support.

Identified facilitators and barriers revealed that user capabilities (care recipients’ cognitive capacities and caregivers’ energy to support their loved ones); user willingness (technology interest) and sufficient support (proactive, continuous and in-person) are three crucial elements in using social technology independently at home.

These contextual factors should be approached from a dyadic perspective taking into account the needs and preferences of both members of the dyad. Technology promoting social participation cannot be developed for people living with dementia without taking into account the needs of their caregivers, and vice versa.

Guidance

Technological solutions that can safeguard the social health of nursing home residents with dementia should be implemented as an integrated part of caregiving procedures. This requires formally incorporated technology guidelines and continuous training of staff. As developing and implementing technology to promote social participation faces substantial barriers as long as social health is not recognized on equal terms as the physical and mental health domains, first, social health needs to be acknowledged as a priority which requires major efforts at the societal-, organizational and individual levels.

Explanation and examples

Cross-sectional data from a national online survey conducted among German nursing homes, on the impact of the COVID-19 pandemic, showed that efforts were made to ensure social participation among residents with dementia, and the use of technology in doing so.A large proportion of respondents observed an increase in at least one Behavioural and Psychological Symptom in Dementia (BPSD) in residents with dementia. Many reported that social activities in the nursing home were cancelled, which was due to COVID-19 cases and staff shortages from 5 % and up, revealing just how easily neglectable social health strategies in nursing homes are. Half of all respondents reported having had no formal training in the use of social technology to engage their residents with dementia. Although more than 70% had provided opportunities for using technology for social purposes, the low frequency of established procedures seems to indicate ad hoc solutions to ensure the social health of residents with dementia.

At the micro-, meso- and macro level requirements were identified to promote social participation using technology. These requirements revealed that integrating technological solutions in institutional settings, requires efforts at individual-, organisational and societal level.